Demography and vital health statistics online.pptx

Detailed notes on demography and vital statistics

1. Demography and vital health statistics Florence F. A. Hawa( Mrs. )MPH,KRCHN(pb) Principal lecturer

2. Module competence The learner will be able to plan and conduct a community diagnosis to evaluate the health status of a community Module outcome The learner should be able to identify indicators of a healthy community

3. Learning objectives Concepts, history Importance of demography Population dynamics-( births , deaths and migration patterns) in relation to age , sex, geographical distribution

4. Definition of demography It is the study of human populations – their size, composition and distribution across space – and the process through which populations change. Births, deaths and migration jointly produce population stability or change https://www.suda.su.se/education/demography

5. history John Graunt (1620-1674) is the pioneer of demography and he produced the first life tables in 1854 James Stark recorded death by social class in England in Register House, Edinburgh in reaction to the Scottish  Registration  Act Florence Nightingale (1820-1910) Applied statistical analysis to health problems, contributing to the establishment of epidemiology and public health practice. Developed  statistical graphics eg bar charts. First female member of the  Royal Statistical Society 11/14/2020 F.F.A.Hawa ( Mrs ) 7

6. Importance of demography useful for understanding social and economic problems In a community and identifying potential solutions. Demographers are engaged in social planning, market research, insurance forecasting, labor market analysis and economic development .

7. Population dynamics   population  refers to the number of people that live in a particular geographic area at the same time, with the capability of interbreeding. dynamics refers to a pattern or process of change, growth, or activity 11/14/2020 F.F.A.Hawa ( Mrs ) 9

8. Population dynamics is the branch of life sciences that studies the size and age composition of populations ,the biological and environmental processes . or  is the study of how and  why populations  change in size and structure over time.

9. P opulation’s composition may be described in terms of basic demographic features – age, sex, family and household status – and by features of the population’s social and economic context – language, education, occupation, ethnicity, religion, income and wealth .

10. Composition of populations The distribution of populations can be defined at multiple levels (local, regional, national, global) and with different types of boundaries (political, economic, geographic). Demography is a central component of societal contexts and social change .eg change in food habits

11. Factors that affect population growth   birth rate- educated women delay having children since they prefer to work and concentrate on their career death rate- Level of medical provision. Often death rates are reduced before a slowdown in birth rates   Immigrants  -due to their large numbers and their fertility since they are working-age adults emigration – outward eg rural- urban 11/14/2020 F.F.A.Hawa ( Mrs ) 13

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13. METHODS USED TO COLLECT DEMOGRAPHIC INFORMATION Civil registration issuing identity cards, registration of births and deaths Special community surveys e.g. community diagnosis Health facility records Epidemiological studies Population distribution Population density- population pyramid

14. A vital statistics system is a subdomain of demography It is the total process of collecting by civil registration, enumeration, or indirect estimation, information on the frequency of occurrence of vital events, selected characteristics of the events and the persons concerned, and the compilation, analysis, evaluation, and dissemination of these data in summarized statistical form

15. Importance of vital health statistics data and information collected is essential for: 1)improving reproductive, neonatal, and adolescent health outcomes, policies and initiating maternal and child health services, including child immunization programs 2) measuring progress towards achieving many of the sustainable development goals eg maternal health .

16. Importance of vital health statistics It contributes to the study of: population size and growth trends, national and subcounty economic and social concerns such as health, welfare, education, occupation, housing, urbanization, family structure, and income are also affected by these measure

17. Types of vital health statistics Vital statistics  comprises accumulated data gathered on a number of important  events  in human life . The UN recommends the following priority order: live births, deaths, marriage, divorces, , fetal deaths, annulment, judicial separations eg Khadhis courts, adoption, legitimations, and recognition.

18. Sources of vital health statistics The UN recognizes civil registration system for each country as the preferred source of vital statistics data Other systems include: community surveys eg probability area samples , purposeful area samples eg in epidemics, records-based surveys, and record linkage .

19. What is Civil registration ? It is defined as the continuous, permanent, compulsory and universal recording of the occurrence and characteristics of vital events, births, deaths, marriages, adoptions and divorces in accordance with the legal requirements in each country. one-quarter of infants do not have their births registered world wide . Most under-five deaths occur in the first week of life,making it easy to miss newborns in the civil registration and vital statistics systems. They will also not have a medically certified cause of death .

20. This Photo by Unknown Author is licensed under CC BY-SA Uses of Vital Records and Vital Statistics mainly 2 1)They have value individually as legal documents for the persons named thereon eg death certificate 2)they constitute the input , when aggregated, for the various vital statistics measures that are used to study the demographics and health of populations and population subgroups eg maternal mortality rate

21. Uses of Vital Records and Vital Statistics 1)A birth certificate establishes name, parentage, birth data, order of birth for multiple births, legitimacy, and citizenship, nationality, or geographic place of birth. :proof of age for school entrance, motor vehicle drivers’ licenses, military service and other age-related activities 2)The death record provides documentary proof of the facts of death needed for social security and insurance purposes such as time and place of death and the medical cause of death. Proof of death and the associated facts are also used for property inheritance rights, for remarriage rights of surviving spouses, for the updating or clearing of files such as electoral rolls, social security files, disease registers, cohort follow-up studies and tax registers

22. Use of vital records and statistics 3)Marriage and divorce records serve to document rights to special social and economic programs and benefits for the married, including tax privileges for couples, alimony, change of nationality based on marriage, and the right to remarry. 4)Many rights of children, their parents, and their guardians are dependent on records of adoption, legitimation, and recognition .

23. Barriers to data collection infrastructure, legal framework and policies  The health records for infants, children, adolescents and women of reproductive age may not include core information required by the civil registry, health workers who are not aware of their responsibilities and of the importance of birth and death registration. civil registration and vital statistics and health systems not sharing data maintaining and protecting privacy of clients.

24. W.H.O vital statistics definitions The World Health Organization (WHO) definitions which are part of the International Classification of Diseases ( ICD ). These definitions are incorporated in regulations adopted by the World Health Assembly and which each WHO member country has agreed to follow ICD -10 is the last edition of the  International  Statistical  Classification of Diseases  and Related Health Problems published by WHO (9). It is a system of categories to which morbid entities are assigned according to established criteria. Live Birth Fetal Death Maternal Death Infant Death Neonatal Death Perinatal Death

25. Live Birth Live Birth. This is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered liveborn [5].

26. Fetal Death Fetal Death. This is death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles

27. Maternal Death. This is the death of a woman while pregnant or within 42 days of termination of pregnancy , irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes . Maternal deaths may be subdivided into two groups: direct obstetric Vital Statistics, deaths which are the result of obstetric complications of the pregnant state (pregnancy, labor, and the puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of these; and indirect obstetric deaths which are the result of previously existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancy

28. Infant and Neonatal Death Infant death : This is the death of a liveborn infant who dies before completing its first year of life Neonatal Death . This is the death of a liveborn infant who dies during the first 28 completed days of life. These may be subdivided into early neonatal deaths, occurring during the first seven days of life, and late neonatal deaths, occurring after the completion of the seventh day but before the completion of 28 days

29. Perinatal Death Perinatal Death. This is the death of a fetus or newborn infant occurring after 22 completed weeks (154 days) of gestation (the time when fetal weight is normally about 500 g), but prior to the completion of seven days after birth

30. Definitions/calculations of Selected Vital Statistics Measures Crude Death Rate The most common form of mortality measurement is the crude death rate. It is computed from the following formula [3]: mcd = !D P " k, where mcd is the crude death rate, D is the total number of deaths for a given area and time period, usually a calendar year, P is the size of population at risk of dying, usually taken as the estimated population at the midpoint of the calendar year, and k is a constant, usually taken as 1000. The crude rate is so named to differentiate it from various specific and adjusted rates and represents the total or overall death rate without regard to the various component elements which combine to produce the total figure. The crude death rate is usually expressed as “the number of deaths per 1000 persons” for a specified place (country, city, state, etc.) for a given year.

31. Measure Numerator Denominator 10 n Crude death rate Total number of deaths during a given time interval Mid-interval population 1,000 or 100,000 Cause-specific death rate Number of deaths assigned to a specific cause during a given time interval Mid-interval population 100,000 Proportionate mortality Number of deaths assigned to a specific cause during a given time interval Total number of deaths from all causes during the same time interval 100 or 1,000 Death-to-case ratio Number of deaths assigned to a specific cause during a given time interval Number of new cases of same disease reported during the same time interval 100 Neonatal mortality rate Number of deaths among children < 28 days of age during a given time interval Number of live births during the same time interval 1,000 Postneonatal mortality rate Number of deaths among children 28–364 days of age during a given time interval Number of live births during the same time interval 1,000 Infant mortality rate Number of deaths among children < 1 year of age during a given time interval Number of live births during the same time interval 1,000 Frequently Used Measures of Mortality

32. Age-specific death rates Specific rates for different age groups are called age-specific death rates; rates for males and females are called sex-specific death rates, rates for particular causes of death are called cause-specific death rates. Rates may be specific for combinations of characteristics . For example, age–sex– race-specific death rates are computed separately for each age group by race and sex. That is, the denominator of the ratio is an estimate of the total number of events of a particular type that could happen, while the numerator is a count of those that did happen.

33. The infant mortality rate is calculated yearly . it reflects the health of the mother and infant during pregnancy and the year after. which in turn, reflects a wide variety of factors, eg access to prenatal care, prevalence of prenatal maternal health behaviors (such as alcohol or tobacco use and proper nutrition during pregnancy, , postnatal care childhood immunizations and proper nutrition, sanitation, and infection control.

34. a. Unintentional-injury-specific mortality rate for the entire population This is a cause-specific mortality rate. Rate = number of unintentional injury deaths in the entire population estimated midyear population × 100,000 = (106,742 ⁄ 288,357,000) × 100,000 = 37.0 unintentional-injury-related deaths per 100,000 population

35. Morbidity It has been defined as : any departure , subjective or objective, from a state of physiological or psychological well-being. it encompasses disease, injury, and disability. the term refers to the number of persons who are ill, it can also be used to describe the periods of illness that these persons experienced, or the duration of these illnesses. Measures of morbidity frequency characterize : the number of persons in a population who become ill ( incidence ) or are ill at a given time (prevalence ). Commonly used measures are listed in Table 2 in the next slide

36. Measure Numerator Denominator Incidence proportion (or attack rate or risk) Number of new cases of disease during specified time interval Population at start of time interval Secondary attack rate Number of new cases among contacts Total number of contacts Incidence rate (or person-time rate) Number of new cases of disease during specified time interval Summed person-years of observation or average population during time interval Point prevalence Number of current cases (new and preexisting) at a specified point in time Population at the same specified point in time Period prevalence Number of current cases (new and preexisting) over a specified period of time Average or mid-interval population Table 2: Frequently Used Measures of Morbidity

37. incidence rate     the  incidence rate  represents the  rate  of occurrence of new cases of a disease condition observed within a specified period of time Synonyms for incidence proportion Attack rate Risk Probability of developing disease Cumulative incidence

38. Calculate incidence proportion :  In an outbreak of gastroenteritis among attendees of a Christmas party , 99 persons ate potato salad, 30 of whom developed gastroenteritis. Calculate the risk of illness among persons who ate potato salad. Numerator = 30 persons who ate potato salad and developed gastroenteritis Denominator = 99 persons who ate potato salad multiply by 100 Risk = “ Food-specific attack rate” = (30 ⁄ 99) × 100 = 0.303 × 100 = 30.3%

39. prevalence  rate prevalence  rate, is the proportion of persons in a population who have a particular  disease  or attribute at a specified point in time or over a specified period of time. Prevalence  refers to the total number  of  individuals in a population who have a disease or  health  condition at a specific period  of  time, usually expressed as a percentage  of the  population.

40. Calculation of prevalence rate   in 1980 the Framingham Het Study examined 2,477 subjects for cataracts and found that 310 had them. So, the  prevalence  was 310/2,477 = 0.125. ie 12.5 per 100 or 12.5%

41. Demographic use of vital health statisitcs in Kenya maternal mortality fell from 315 ·7 (242·9–399·4) deaths per 100 000 in 1990 to 257·6 (195·1–335·3) deaths per 100 000 in 2016, ( Achoki,Miller et alm2018) Years of Potential Life Lost  (YPLL) statistic, which is simply the sum of the  years  of  life lost  annually by persons who suffered early deaths.  1 . For the purpose of calculating YPLL, premature death is  defined  as death occurring before the age of 65 . See table 3 in the next slide

42. Column 1 Age Group (years) Column 2 Deaths Column 3 Age Midpoint Column 4 Years to 65 Column 5 YPLL Total 14,095 291,020 0–4 12 2.5 62.5 750 5–10 25 10 55 1,375 15–24 178 20 45 8,010 25–34 1,839 30 35 64,365 35–44 5,707 40 25 142,675 Table 3. Deaths and years of potential life lost attributed to HIV by age group — United States, 2002 (CDC)

43. Natality (Birth) Measures Natality measures are population-based measures of birth. These measures are used primarily by persons working in the field of maternal and child health. Crude Birth Rate The crude birth rate is the most frequently used overall measure of the reproduction of a population Table 3.11 includes some of the commonly used measures of natality.

44. Measure Numerator Denominator 10 n Crude birth rate Number of live births during a specified time interval Mid-interval population 1,000 Crude fertility rate Number of live births during a specified time interval Number of women ages 15–44 years at mid-interval 1,000 Crude rate of natural increase Number of live births minus number of deaths during a specified time interval Mid-interval population 1,000 Low-birth weight ratio Number of live births <2,500 grams during a specified time interval Number of live births during the same time interval 100 Table 3.11 Frequently Used Measures of Natality

45. Fertility rates The total fertility rate in a specific year is defined as: the total number of children that would be born to each woman if she were to live to the end of her child-bearing years and give birth to children in alignment with the prevailing age-specific fertility rates. This indicator is measured in number of children per woman . It is calculated by totalling the age-specific fertility rates as defined over five-year intervals. Total fertility can be computed as the sum of age-specific fertility rates weighted by the number of years in each age group, divided by 1,000.  a total fertility rate of 2.1 children per woman ensures a broadly stable population. In 2017, the fertility rate in  Singapore  was estimated to be at 0.83 children per woman, making it the lowest fertility rate worldwide R easons for the dramatic decline in birth rates during the past few decades include: postponed family formation /marriage Postponed child-bearing and a decrease in desired family sizes. Together with mortality and migration, fertility is an element of population growth, reflecting both the causes and effects of economic and social developments. (OECD (2020), Fertility rates (indicator). doi : 10.1787/8272fb01-en (Accessed on 10 November 2020)

46. Replacement-level fertility  TFR of about 2.1 children per woman is called Replacement-level fertility (UN, Population Division). This value represents the average number of children a woman would need to have to reproduce herself by bearing a daughter who survives to childbearing age . If replacement level fertility is sustained over a sufficiently long period, each generation will exactly replace itself without any need for the country to balance the population by international migration

47. Difference between birth rate and fertility rate   fertility rate  measures the number of  births  per 1,000 women of childbearing age (ages 15 to 44) occurring  in a  particular year;  birth rates  refer to this measure within particular age groups.ie number of  births  per 1,000 women of childbearing age (ages 15 to 44) occurring  in a   particular age group( five-year age groups are utilized: 15 to 19; 20 to 24; 25 to 29; 30 to 34; 35 to 39; 40 to 44; and 45 to 49.) The age-specific fertility rate measures the annual number of births to women of a specified age or age group per 1,000 women in that age group. Unless otherwise specified, the reference period for the age-specific fertility rates presented in  World Fertility Data 2008  is the calendar year. Method of Computation An age-specific fertility rate is generally computed as a ratio. The numerator is the number of live births to women in a particular age group during a period of time, and the denominator an estimate of the number of person-years lived by women in that same age group during the same period of time. It is expressed as births per 1,000 women. Data Sources Data on age-specific fertility rates can be obtained from three sources: civil registration systems, sample surveys and censuses. 

48. Adolescent Birth Rate Definition The adolescent birth rate measures the annual number of births to women 15 to 19 years of age per 1,000 women in that age group. It is also referred to as the age-specific fertility rate for women aged 15-19. The numerator is the number of live births to women 15 to 19 years of age, and the denominator an estimate of the number of person-years lived by women at ages 15 to 19 during the same period of time. It is expressed as births per 1,000 women. Data Sources Data on the adolescent birth rate can be obtained from three sources: civil registration systems, sample surveys and censuses

49. Population pyramid in Kenya Kenya National Bureau of Statistics data shows that the population grew by 26% from 37.7 million in 2009 to  47.6 million  in 2019, translating into an additional  9.9 million people . Kenya has a population of  47.6 million people , of which 23.548 million are male, while 24.014 million are females. Types of population pyramids worlwide Stage 1- expanding High birth rate, High death rate , short life expectancy Stage 2- expanding -High birth rate, fall in death rate, slightly longer life expectancy Stage 3-stationary- declining birth rate,low death rate, more people living to old age Stage 4- contracting -low birth rate, low death rate, longer life expectancy and higher dependency ratio

50. references http://www.medicine.mcgill.ca/epidemiology/hanley/c609/Material/VitalStatisticsEoB.pdf https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section2.html Achoki , Miller et al https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30472-8/fulltext World Bank .Life expectancy https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=KE Organisation for EconomicCo -operation and Development OECD (2020), Fertility rates (indicator). doi : 10.1787/8272fb01-en (Accessed on 10 November 2020) https://data.oecd.org/pop/fertility-rates.htm United Nations population Division https://www.un.org/en/development/desa/population/publications/dataset/fertility/age-fertility.asp